The Silent Impact of Stigma Surrounding Mental Health in the Workplace

What does it look like, why isn’t it talked about, and how can you help? Mental health experts weigh in.

Let’s explore a world that is seldom seen—one that is puzzling to many and whose very existence is often called into question. Let’s investigate a world where a swelling number of people quietly live and work, but rarely discuss. Historically, many invisible diseases have gone through an early period of dispute between those who wish to bring attention to it and those who perhaps unknowingly stifle the conversation. Mental illness is at this crux.

What does mental illness look like, and how can it impact performance at work? 

According to the National Institute of Mental Health, 46.6 million adults in the US, the approximate population of Spain, live with a mental health illness. 41% of UK employees have experienced symptoms of mental illness at work according to the AXA PPP Health Teach Survey in 2017.

Mental illnesses are health problems that affect the way that we think about ourselves, relate to others, and interact with others around us. They affect our thoughts, feelings, affinities, and behavior. Depression and anxiety are the most common mental illnesses.

Mental illness is more likely to come up during times of stress or uncertainty, which can be part of many people’s jobs; however, pressures outside of work can also affect mental health. These external pressures can affect a person at work. It’s important to understand that mental illnesses are real illnesses like diabetes or asthma.

Most mental illnesses are episodic, which means they happen at certain times in a person’s lifetime. It means that there are periods where a person may be more productive, overall healthy, and functioning. If changes are noticed in an employee who is usually reliable and consistent, it’s possible they are experiencing something traumatic outside of work that has led to a change in their behavior. Checking in with the employee can be helpful, but it’s crucial to respect their privacy if they are broad in their explanation and to listen to their suggestions for what could help.

According to the World Health Organization, half of all mental illness arises by age 14 in the US, two-thirds by age 24.

In part, thanks to an escalating culture of instant gratification, peer comparison driven by social media, and crippling student loan debt, depression and anxiety are on the rise; especially among young people. Depression is up to a whopping 47% among millennials between 2013 and 2016, and 63% in the same period for 12 to 17 year-olds, who are next to join the workforce.

Gainesville, Florida had the second highest rate of diagnosis out of the 17 Florida cities analyzed in the study, well above the state and national averages. This rate could be due to the disproportional population of students and young professionals in the community.

Like professionals, graduate students can often feel immense pressure while working. Add the loss of a relationship, the death of a loved one, or the water heater breaking to that, and you have a period that is going to be overwhelming for most people. It does not mean they are abnormal or have lost their value. It means they are human.

This 2018 Nature Biotechnology survey, as reported here in Science Magazine found:
41% of Ph.D. candidates showed symptoms of moderate to severe anxiety
39% showed signs of mild to severe depression

PhD Balance is an excellent source for long-form personal stories from graduate students struggling with mental illness and can be a helpful forum to connect with others or get involved.

With millennials now representing the largest generation in the American workforce (35%), employee mental wellness is something every company should consider incorporating into their culture. It’s one of those things that perhaps should have started getting play at HR meetings a while back, but which businesses are only now coming to grasp. The fact that a session about mental wellness had a packed house last year in one of the largest rooms at INBOUND, one of the country’s most significant marketing conferences in the US, points to the growing interest in the topic among the business community. Many organizations are now starting to implement guided meditations and yoga in the workplace or offer third party mindfulness workshops to help with the growing problem.

A company or academic department should want to breed leaders and change agents not only to fuel the health of the organization but to fuel the health of the team members, themselves. If a team feels supported, listened to, and inspired by their environment even when life gets hard, it can enhance their experience and that of those around them.

According to the National Institute of Mental Health, the leading cause of absenteeism in the United States is depression. According to research from the Center for Prevention and Health Services, this costs US employers between $79 and $105 billion annually.

Tom Oxley, a mental health expert who conducted 170 interviews and reviewed 15,000 survey responses on the matter, reports that mental health is responsible for 30% more absenteeism than any other factor. “People who struggle with mental health, want to be at work,” Oxley states. It is important to remember that people don’t choose to have a mental illness and are likely already trying to avoid letting it interfere with their life at work.

Anoushka Marcin, a renowned speaker, and writer on the topic of mental health at Balance Psychologies, explains that work is essential to our well-being, our identity, how we understand our skills, and our opportunity to be creative; however, mental illness can have a significant impact on the way we work:

“How do mental illnesses impact workers and the workplace? People who experience mental illnesses may doubt their abilities or appear less confident. A person may have a hard time concentrating, learning, and making decisions. This detrimental thinking may feed much bigger thoughts. Someone who can’t concentrate and thinks they can’t do the job very well will fear they may lose their job. It’s easy to see how these thoughts affect performance,” Marcin explains.

She adds, “Mental illness also affects relationships. People with mental illness may tend to withdraw from others and act in unexpected ways. They may take more time off or appear less productive than usual. This absence can strain relationships with supervisors and co-workers if mental illnesses are not understood”.

The disconnect between employers and victims of mental health disorders is often cyclical. Employees avoid talking about it because they fear repercussions, so employers don’t hear about it or know how to handle it when they do. The lack of healthy dialogue diminishes the chances of investment in wellness solutions, management training programs, suitable accommodations, and consequently, positive outcomes for both parties.

How does mental health stigma impede a positive dialogue at work and what should be considered before disclosing your concerns to employers?

One of the biggest deterrents of being honest at work when we’re struggling is the risk of being labeled as someone who can’t keep it together. The repercussions of that can extend widely. There could be scrutiny from management for signs of incompetence or co-workers could become afraid of how to handle conversations with someone who’s struggling at the moment. What people should remember is that we all struggle sometimes, and the best thing to do is try to be supportive.

“They feel they can’t talk to their boss. If they take time off, they give a different reason. We don’t talk about mental health in the workplace until we’re past the breaking point when it can be more difficult to address”, Oxley adds.

These are sentiments echoed by Mental Health Therapist and ACEL: Alachua County Emerging Leaders member, Alea Wise, from Play & Wellness Center of Gainesville:

“The part that’s a big deal is that it’s usually not talked about at all and when it is talked about, it’s in a crisis mode, so it’s not talked about regarding the day-to-day, life being hard, stressful part. It’s important to advocate for conversations. Stress of mental health affects so much of physical health. When people ask, ‘are you healthy,’ they don’t think about the mental health part of it. Stress contributes to heart disease and other things, but it’s not discussed”, Wise explained.

The American Heart Association has concluded that depression can accelerate atherosclerosis as well as promote the onset and severity of the coronary risk factors of diabetes, hypertension, and high levels of low-density lipoprotein.

“As far as with my clients, I don’t think most of my clients talk about going to therapy, but if they do, I always feel protective of them, because I want them to make sure they’re telling it to a safe person who isn’t going to be part of that stigma culture. Often, it’s a culture of ‘manage the symptoms and let’s get out.’ For the employer, it’s important for them to listen to the employee versus trying to fix the person or the situation,” Wise offered.

Everyone’s situation is different. The person affected by mental illness may have been experiencing it throughout their life as stressful events arise, so are likely used to trying to recover, since they don’t want to feel this way. It is important to consider reasonable accommodations from them, though, the fact of the matter is that not every company is going to be open to this.

Tom Oxley, the mental health researcher who was mentioned earlier, compared two situations he was familiar with from his research. In one, “Nick” asked for additional time off after his mom passed away, but his request was denied because the company felt everyone would want it. At another company, after “Sally” experienced the loss of her father, the company let her work from home and have a phased return, which helped her be more productive outside of the office environment, which some can find overwhelming during times of stress.

When asked, what kind of benefits can employers offer to help during times of need, Wise suggests, “Being able to call out when you need a break can help. Lots of jobs are very stressful, so allowing there to be a paid number of times you can take off for mental health could allow employees to recharge. Research shows that having space and downtime in the work experience allows people to succeed, perform better, and be more efficient. If the space is available during these times, they’re going to perform better and continue to be fit for their duties and future opportunities”.

In the effort of transparency, Wise’s suggestion makes sense since year after year mental health continues to be the most significant cause of absence in the workplace, anyway. Such a policy would avoid unnecessary lies about taking time off and could even open a dialogue about changing workload needs before they become harder to address later on.

For others, though, time off may not help at all. Being around other people and diving into one’s work can help with the healing process, especially if it’s episodic. Staying connected to work can be helpful during recovery. Marcin suggests, “It can contribute to skills, build social connections, and allow you to work toward something bigger. A job can be part of how you see yourself. If your office has a care team, talk to them about your options and any services offered”. Work can often bring the consistency needed during difficult times and give a struggling person something to focus on that can aid in improving their self-esteem.

Wise added, “People who are more isolated are going to live in their pain longer. Connection breeds healing so without the connective part of being in pain and the empathy or the vulnerability that’s being shared, then there’s going to be more of this pushing away of the authentic experience of struggling. That’s the thing I say over and over: life is hard. It’s not because there’s anything wrong with anyone. It’s hard. There are going to be things that arise: heartbreak, job changes, death. It’s harder at different times, and there has to be space for these events to be processed. Having people around who can empathize can help a lot”.

Fewer than half of the people who need help, get it, often because of social stigma, the fear of repercussions at work, or lack of access to quality, affordable care.

A study by the Centre for Addiction and Mental Health in Canada found that nearly 40% of employees would try and cover up a mental health issue from their manager if they could.

Chiradeep BasuMallick, a freelance contributor for HR Technologist, explains this phenomenon well:

“One obvious reason is that the majority of the workforce believe asking for help could prove detrimental to their careers. They might be perceived as incompetent or unable to perform in high-stakes work scenarios – a notion that other health challenges don’t carry. Another reason might be a break in communication lines – employers fail to educate the workforce about what constitutes good mental health, employees may not be aware of the plans available at hand, and the assurance that mental illness can be treated and need not be debilitating – like any other ailment – is absent.” This potential disconnect between employers and employees can come out in different forms.

Sometimes, due to a lack of focus on mental health in a work environment or no previous experience with it, a mental health problem can be miscategorized and dismissed as addiction or substance abuse. While these are distinctly separate conditions, they can result from untreated mental health illness and may be the first things employers jump to because they are more familiar and commonly discussed.

Addiction and substance abuse carry their unique stigmas, often fewer protections, legally, and require entirely different solutions, so it is essential to clarify that this is not the case. If you see a mental health professional, this might be the time to get them involved to provide your employer with their expert opinion on what you are experiencing. Beyond clarity, this information can also help your employer understand how individual accommodations can help you.

It can hurt not to feel believed or listened to, but this is, unfortunately, going to be the case at a lot of organizations until the narrative changes. Do your best to have compassion for those who are trying to help. It is important to remember that mental health issues are often hidden, so there may not be a precedent for handling a matter like this properly at every workplace.

If you choose to disclose your condition to a supervisor or human resources representative, according to Marcin, you should “explain that you are experiencing health challenges and describe what you need to work well.”

Marcin continues, “Disclosing can lead to stigma or discrimination. Unfortunately, being open about mental illness can impact their position in the workplace or their ability to find a new job after the fact. There are laws in place to prevent this type of discrimination, but it can still happen. Workplaces have different attitudes and cultures, so everyone will have different experiences. It’s best to consider all the options before deciding to do so”.

It is also recommended to reach out to support networks outside of management like family, friends, or confided co-workers. Maintaining connection is vital when going through a difficult time.

When it comes to disclosure, Mental Health Therapist, Alea Wise elaborates further, “It depends on the person’s willingness to be vulnerable, the supervisor, and the corporate structure. Hopefully, the conversation would be, ‘Yes, I am off. I’ve been struggling right now. I could use more ‘XYZ,’ I could use more time for this deadline, or it would help to work from home for a few days.’ Sometimes people have to be their own advocate in the workplace because there’s not a therapist there. Because mental health hasn’t gotten to the point where it’s common practice for it to be discussed, I think it’s important for people to be careful about who they’re vulnerable with. Because of the stigma that’s in the workplace, [sic] not wanting any labels to be placed on them, it could be safer to be broad rather than specific about the type of mental health problem you’re experiencing. What if it was as normal to go see a therapist when you were feeling sad as it was to see a doctor when you were feeling sick?” There is no perfect solution to this dilemma at the moment. You should be prepared for any push back or consequences of trying to seek help from your employer before you decide to do so.

One expert making waves regarding the topics of vulnerability and connection in the workplace is Dr. Brené Brown, a research professor of social work at the University of Houston and author of the book, Dare to Lead: Brave Work. Tough Conversations. Whole Hearts, where she discusses the part leaders play in establishing a culture of safety, courage, and vulnerability.

Brown says, “By the time you’re a social worker for ten years, what you realize is that connection is why we’re here. Neurobiologically, that’s how we’re wired”. Understanding the link between connection and happiness is the preface to an even more substantial conclusion she reached.

During her research, she ran into something that she concludes unravels connection: “It turned out to be ‘shame.’ Shame is easily understood as the fear of disconnection. ‘Is there something about me that if other people know it or see it, that I won’t be worthy of connection?’”. The shame surrounding mental health disabilities in the workplace can add intense stress, feelings of incompetence, alienation, and humiliation in a situation that is otherwise already difficult and prone to hardship, especially if an employee feels their job is being threatened as a result of their disability. It can be extremely damaging for an employer to gloss over the difficulties an employee may be experiencing and equate it to incompetence that deserves punishment, sometimes publicly.

Brown continues, “What underpinned this feeling of ‘I’m not good enough,’ was excruciating vulnerability—that for connection to happen, we have to be willing to be seen.” It takes courage to talk about these topics. It may result in consequences for most people for many years to come, but the way we fight stigma is by normalizing the subject of it. We need to talk about it and show that it’s not isolated. Mental illness impacts enormous amounts of people every single day.

Another way Brown found we can push through the shame is by feeling worthy of connection – believing that we are. She discovered that what it takes to do that is to have courage and compassion. We need to understand that being vulnerable is beautiful and necessary. “It’s the willingness to do something where there are no guarantees.” And there are no guarantees when it comes to workplace stigma. Neither the laws nor the culture has entirely caught up, but understanding that regardless of your imperfections, you are worthy of connection, is influential in the face of ignorance.  

Brown explains, “I know that vulnerability is kind of the core of shame, and fear, and our struggle for worthiness, but it appears that it’s also the birthplace of joy, creativity, of belonging, and love. We can’t selectively numb those. When we numb those [shame, fear, and our struggle for worthiness], we numb everything. We numb joy and belonging…”. It is true that you can often feel pressured to not be your authentic self in the workplace when you’ve experienced a loss or are just not feeling well, to avoid “impacting morale,” but Brown argues that suppressing those emotions prevents one from moving past them.

The pervasiveness of mental health stigma in our culture is so strong that many people will naturally do this to avoid bringing attention to themselves and start out feeling like they don’t deserve connection when they have these feelings. If it seems an employee is embodying these contradictions, it might be useful to check in with them and see if they’d feel better working from home for a bit.

So, how did we get like this? One of the first negative connotative words for mental illness was “hysteria,” which comes from the Greek word for uterus, hystera (ὑστέρα). Hysteria was thought to manifest itself in women with seemingly arbitrary symptoms.

But while the science community has since discarded hysteria, even today, we still throw words around that are not used correctly and can devalue illness. Sometimes people will say they are experiencing a panic attack when they mean to say they are stressed or shocked by something. A panic attack is actually a serious condition that can feel like dying, so if a person that has had that experience hears it being discussed flippantly, it can minimize their affliction and deter them from speaking with anyone about it in the future.

More commonly, the word, “crazy” is used to categorize a wide range of actual disorders and can be extremely dismissive. If we are to change the narrative, we have to start with the language.

It’s easier said than done, though. Wise typically feels compelled to set the record straight with new clients who may have themselves convinced they are not typical. She lets them know, “You’re not coming to me because you’re crazy. You’re not coming to me because you’re broken. You’re coming to me because life is hard and having support along this journey is important and helpful regardless of the mental disorder you have”. As Wise and Brown infer, before we can change the minds of others, we have to change the narrative in our heads about ourselves.

How can we help support co-workers in need, end mental health stigma, and bring awareness to the gravity of the problem? What incentive do employers have to implement solutions?

First, when we think about solutions, we should ask, “what’s some low hanging fruit”? What can impact the most people the fastest at the lowest cost? Sleep difficulties and insomnia are very prevalent and directly linked to anxiety and depression.

Mental health solutions are top of mind for most companies according to Sophie Bostock, a Sleep Evangelist at Big Health, the digital medicine company behind the sleep improvement application, Sleepio, which positions itself as “the stigma-free way to address mental health.” In this HR Technologist blog, she begs the question, “are you seeing rising levels of stress, anxiety, or depression in your employee population?”, as recent research shows, it is now more probable to suffer from mental illness than diabetes, heart disease, or any cancer combined.

She notes a 2017 survey by Willis Towers Watson that found 88% of employers say behavioral health is an essential priority over the next three years.

Bostock insists what employers don’t know is that stress and sleeplessness go hand in hand. She argues that while “sleep problems have long been recognized as symptoms of anxiety and depression,” impacting the 1 in 5 people who have insomnia, it appears actually to work the other way too. We now know that otherwise healthy individuals with insomnia are twice as likely to develop future anxiety or depression compared to good sleepers, according to a study published in the Journal of Affective Disorders by Dr. Chiara Baglioni and another published by Dr. Dag Neckelmann in the journal, Sleep. It can also lead to more severe mental disorders, including suicide, according to a study published by Dr. Y. Okuji in the Journal of Psychiatry and Clinical Neuroscience. Given these conclusions, insomnia has been getting much more attention from the American Psychiatric Association in the last decade.  

Bostock sees sleep as a perfect opportunity to help people’s mental health. She asks, “So what does this mean for HR professionals.” She continues, “Everyone wants a good night’s sleep, and there is no stigma to admitting that. Sleep offers a unique opportunity to engage vulnerable employees in programs to improve their sleep, and – in so doing – their mental health. While targeted programs for stress or anxiety may be hindered by the barriers of admitting to a problem, sleep can be used as a de-stigmatized ‘trojan horse’ for addressing mental health”.

Bostock interprets this opportunity as a kink in the armor of the culture of stigma surrounding mental health. Sleep problems are usually not as controversial as it might be to disclose other disorders that carry a more significant stigma, though it would still quietly be helping people with those disorders as the information found in these studies is not common knowledge.

The conclusions reached by the scientists as mentioned earlier in combination with greater interest from psychiatrists has opened up the door for research that leads to a now increasingly popular method of treatment called, Cognitive Behavioral Therapy for Insomnia (CBT-I). It is suggested as a first line treatment that focuses on “teaching poor sleepers techniques to address the mental or cognitive factors associated with insomnia, like the ‘racing mind,’ as well as behavioral strategies to establish a healthy sleep pattern.”

These are the origins of the suddenly booming market for sleep therapy applications and programs, which can be very low-cost tools employers can use to impact as many team members as possible. The more progressive companies get about how they see mental health, the more these technological opportunities and others will come to the forefront and become the norm.

A 2017 study by Brigham Young University found that 76% of respondents were interested in free mobile phone apps to maintain their mental health. Those respondents may start to have their demand met as Willis Towers Watson reports that by 2020, 27% of employers are expected to offer mobile sleep applications to workforces, a growth of 5x.

On mental health solutions, Tom Oxley states, “Mindfulness, meditation in meetings, virtual reality glasses to train managers, reporting on workplace illness as well as injury, little robots that pop up on your screen to ask you how you are, psychotherapy through our mobile phone—those things are being trialed right now. They’re just around the corner. But here’s the thing: your people don’t need you to throw lots of money at this. What they want from you is to know that they can speak safely about mental health”. At the micro level, these are all tools worth exploring for an organization, but when it comes to changing the culture, advocates, and people willing to be seen, as Dr. Brené Brown emphasized, is what will make the most significant impact.

When it comes to mental health advocacy, it is hard to find a better example than John T. Broderick, former Chief Justice of the New Hampshire Supreme Court. He now dedicates his life to advocating for mental health awareness to eliminate the stigma surrounding it, once and for all. He tours around 50 high schools a year speaking to the generation he considers to be the most open and least judgmental in history. It also happens to be the one currently most impacted by mental health disorders, statistically. He hopes that by communicating these topics early in life, we can finally put a stop to the cycle of silence and ignorance.

Justice Broderick was personally impacted by mental health illness when a misdiagnosis of his son as having an addiction problem led to him and his wife giving him “tough love” by putting him in the street, a decision Broderick regrets to this day. The trauma his son experienced during his time being homeless sent him down a self-destructive spiral that eventually crested in the form of assault against Broderick and years in prison. It was only then that he was evaluated by a professional who discovered his problem was not alcohol—it was severe anxiety and depression that went untreated until then. After treatment, his son finally felt like himself and was able to lead a functioning life for the first time.

Broderick feels his early ignorance of the signs of mental illness and his generation’s stigma of mental health led to a preventable catastrophe for his family. “My family’s tragedy is that it happened at all,” Broderick states matter-of-factly to the auditorium of high school students. “We need to take away the shame and the stigma. It needs to be talked about.”, he adds.

An essential part of bringing awareness to this issue is highlighting how common it is. “More people died of suicide than any car accident last year,” Broderick says. Not a lot of people are aware of this hugely impactful statistic. Data can speak volumes about a problem.

While mental health is rising the fastest among young people in general, it’s important to note the impact of mental health illness on veterans of any age, who’s suicide rate continues to increase. According to the US Department of Veterans Affairs, the average number of veterans who commit suicide every day is 20.

Broderick told the students that his son often tells him, “Dad, anyone with a mental health problem—anxiety, panic, bipolar, depression…it doesn’t matter. They have two things in common:

1. They didn’t ask for it.

2. They don’t deserve it.”

This cannot be stressed enough. Anyone with a mental health disorder has felt the frustration of being told to “stop it” as if they have a choice. They don’t. Otherwise, they would.

“If someone had diabetes, would you tell them to snap out of it? If they knew how they wouldn’t be depressed. Like people don’t pick their eye color, they don’t choose to have a mental illness.”, Broderick elaborated. One of the biggest misconceptions about mental illness is that it is different in this regard from any other disease. Since it can’t be seen, people who don’t know what it feels like to experience severe levels of mental illness often dismiss or diminish it as a weakness in the victim’s will.

The reason Broderick goes to so many high schools is that he is trying to find more advocates. He’s trying to create a new culture of awareness. It takes courage to speak about this, but it becomes less frightening as more people talk about it and acknowledge the problem. It’s about numbers.

Broderick explains that when he was younger, people whispered the word “cancer.” It just was not polite conversation. If someone had it, the conversation was had quietly behind the scenes. He said in those days, the only person that said the word “breast” was Hugh Hefner of Playboy Magazine. One day some good people decided to combine those words, go to the streets, and start talking about it. He adds, “300,000 women had breast cancer diagnoses last year. Their results are dramatically different. Why? Because we finally started talking about it”. This is just one of many historical examples where bringing awareness to an illness helped people eventually get the treatment they deserved.

Broderick also gives the example of HIV/AIDS, where when people started dying from it, nobody understood it. There was widespread ignorance. People weren’t sure if they could catch it from touching the person, and when someone had it, they were avoided and alienated from the community. It wasn’t until Magic Johnson, the basketball star, announced he was HIV positive that people realized it could happen to anyone. Thanks to the awareness that came from that, today, drugs in the trial period have been developed to completely suppress the transmission of HIV that affects 40 million people worldwide. To get to this current point, the stigma had to be removed.
Addressing the students, Broderick states, “It’s way past time that we changed it. You can do that…if you want. My generation—the baby boomer generation, failed miserably. Our solution was don’t talk about it, hide it, keep it a secret”, emphasizing the impetus that he feels now falls on them.

Broderick offers the members of the crowd personal accounts of his experience touring high schools saying, “Sometimes when I go to high school gyms or other places, people come up to me with wet eyes and cracking voices, and say, ‘Thanks for coming; thank you for talking about it.’ When I ask if they’re supported, they say, ‘I don’t talk about it; I might not have any friends.’ I cannot imagine a crueler act than to make fun of someone who has a brain chemical imbalance”.

Addressing the students with urgency, Broderick forewarns, “Someday many of you will have children. Statistically, some of them will have mental health problems, so when do you think would be a good time to change the discussion—to start a different conversation without judgment or stigma? We should do it now or should we wait for your children and they can sit on the bleachers with wet eyes? It’s not right. It’s not morally right. And it’s not necessary”. Multiple generations have now avoided the topic. Young people are displaying the fastest growth in mental illness, so Broderick hopes that addressing them is the best chance for enacting a change to the status quo.

He concludes, “It will impact you in your life if it hasn’t already. Talk about it. Help someone. Or we can just keep kicking the can down the road and say, ‘we’ll just keep it quiet’, and we’ll lose another generation to the shadows. We need to change. My generation had an opportunity and they didn’t seize it. Your generation needs to force the discussion. There’s no shame and there’s no stigma. I need your help”. Broderick wishes to keep calling students to action as long as he can in the hope that someday nobody will have to endure his family’s tragic experience.

Justice Broderick first got involved with mental health advocacy when Dr. Barbara Van Dahlen reached out to him to see if he could help. Dahlen is a clinical psychologist who was named one of Time Magazine’s 100 most influential people in 2012. She is the president and founder of Give an Hour ™, a non-profit organization that encourages mental health professionals to donate their time to those in need. They also lead an initiative called, “The Campaign to Change Direction,” with the goal “to change the culture of mental health so that all of those in need receive the care and support they deserve.” Their website provides many resources to support a positive conversation about mental health.

A common way that you can help is by simply being aware of the signs of mental illness. Their website offers these five easily memorized signs that someone you know could be suffering from mental health illness:

Personality Change – Their personality changes. You may notice sudden or gradual changes in the way that someone typically behaves. He or she may behave in ways that don’t seem to fit the person’s values, or the person may just appear or act different.

Agitated – They seem uncharacteristically angry, anxious, upset, or moody. You may notice the person has more frequent problems controlling his or her temper and seems irritable or unable to calm down. People in more extreme situations of this kind may be unable to sleep or may explode in anger at a minor problem.

Withdrawn – They withdraw or isolate themselves from other people. Someone who used to be socially engaged may pull away from family and friends and stop taking part in activities he or she use to enjoy. In more severe cases, the person may start failing to make it to work or school. Not to be confused with the behavior of someone more introverted, this sign is marked by a change in someone’s typical sociability, as when someone pulls away from the social support he or she typically has.

Poor Self-Care – They stop taking care of themselves and may engage in risky behavior. You may notice a change in the person’s level of personal care or an act of poor judgment on his or her part. For instance, someone may let his or her hygiene deteriorate, or the person may start abusing alcohol or illicit substances or engaging in other self-destructive behavior that may alienate loved ones.

Hopelessness – They seem overcome with despair and overwhelmed by their circumstances. Have you noticed someone who used to be optimistic and now can’t find anything to be hopeful about? That person may be suffering from extreme or prolonged grief or feelings of worthlessness or guilt. People in this situation may say that the world would be better off without them, suggesting suicidal thinking.

A person may not display all of the above signs, but if you notice some of them, it would be good to check in to open up the opportunity for them to ask for help if they need it or even to just make them feel seen.

According to the 2017 Willis Towers Watson study, more than one quarter (28%) of employers already provide educational programs about the warning signs of behavioral health issues or distress. Another 41% are planning or considering action over the next three years.

So how can we support a co-worker, friend, or relative if we recognize the signs of mental illness? It’s actually rather simple. Anoushka Marcin from Balance Psychologies suggests, “If you noticed changes, express concern without making assumptions. Listen without judgment. Ask how you can help and respect their decision”. She offers some guidelines you can keep in mind to support a healthy work environment:  

1. Ask how you can help-and respect your co-worker’s wishes.

2. Continue to include your co-worker in the workplace’s usual activities.

3. Depending on your relationship, you can still keep in touch with a co-worker who takes time off.

4. When a co-worker returns to work after time off due to mental illness, make them feel welcome and appreciated. Saying nothing because you’re worried about saying the wrong thing can make your co-worker feel worse.

5. Advocate for healthy workplaces. Many wellness strategies are low-cost or no-cost, but they can still improve everyone’s well-being and build inclusive spaces.

So, beyond making their team feel better, what incentive do employers have to apply the solutions and enable the culture recommended by all of these mental health experts? There are many. This is a mutually beneficial position for a company or academic institution to take. For one, it impacts the bottom line significantly. A report from the National Alliance of Healthcare Purchaser Coalitions (NAHPC) found that more comprehensive coverage for mental healthcare could bring a financial return of four dollars for every one dollar spent.

As mentioned earlier, research from the Center for Prevention and Health Services estimates that the cost of mental illness and substance abuse disorders in the workplace cost employers between $79 to $105 billion each year.

The Center for Workplace Mental Health, a branch of the American Psychiatric Association Foundation, offers mental health calculators to help employers estimate the prevalence of the disorders in their workforce, their cost to the bottom line, and the potential savings from implementing intervention programs. The calculators create personalized reports, based on your workforce demographics, that can be used to show the importance of prioritizing mental health in your workplace.

While absenteeism and presenteeism related to mental health problems significantly contribute to this cost, another factor is turnover. In 2017, Prime Minister Theresa May commissioned the Thriving at Work report for the British government to review “how employers can better support all individuals currently in employment including those with mental ill health or poor well-being to remain in and thrive through work.” It revealed that an estimated 300,000 people with long-term mental health conditions lose their job in the UK each year, costing UK employers up to £42 billion annually. The report explored ways employers can work to reduce those figures.

After reading the report, Prime Minister May confirmed that the British government would abide by the report’s recommendations, providing 2 million public sector workers with unprecedented mental health support.

May said, “We’ll be ensuring that the support is there. I want other employers to do so too”. She continued, “I have made it a priority of this government to tackle the injustice of mental illness…it is only by making this an everyday concern for everyone that we change the way we see mental illness so that striving to improve your mental health—whether at work or at home—is seen as just as positive as improving our physical wellbeing”.

Among the recommendations, it is advised that employers encourage open conversations about mental health and the support available when employees are struggling, yet it also found that only 11% of UK employees discussed a recent mental health problem with employers.

The Thriving at Work report stated, “…increasing employer transparency presents the biggest opportunity to encourage a greater breadth and depth of employer action on mental health, and strong leadership is vital to ensuring this change is felt throughout organizations.”

Before passing last year, British Cabinet Secretary, Jeremy Heywood, had this to say regarding mental health stigma in the workplace: “In my experience, there is a strong correlation between the authenticity of an organization’s support and commitment, and the willingness of staff to speak up. This is governed by how supported individuals feel and how visible, active, and credible their most senior leaders are on this front”.
The report outlined six “core standards” for employers to follow:

1. Produce a mental health at work plan that is not only implemented but well communicated to staff

2. Develop greater mental health awareness among employees

3. Encourage open conversations about mental health, and especially the support that’s available to employees

4. Provide excellent working conditions to employees and ensure that they have a healthy work/life balance

5. Promote strong people management so that employees are supported

6. Routinely monitor mental health and wellbeing among employees

The theme here is communication. There has to be communication about mental health—between management and staff, among peers, and at the leadership level where they should always be considering innovative ways to improve conditions and promote wellness. Doing so can reap the rewards for all involved. 

A 2009 Sainsbury Centre for Mental Health analysis found that UK businesses can save up to £8 billion per year (likely more since the study was conducted) by implementing practices like these. Employers are starting to catch wind of the growing need for change. The Willis Towers Watson survey found that 52% of employers are expanding access to mental healthcare over the next three years.

Data shows the financial advantages of investing in mental health are unequivocally lucrative. Doing so will also support your team in their efforts to be happy and more productive. The data also shows this is where companies are already going. Some are even making efforts to bring on in-house support to suppress suffering, as a result of the increasing severity and widespread impact of poor mental health.

The National Alliance of Healthcare Purchaser Coalitions (NAHPC) provides guidelines for organizations compiled in collaboration with many stakeholders, including employers, health plans, behavioral organizations, and providers:

Improving Access

• Promote and reimburse for collaborative care in primary care settings

• Take proactive steps to ensure affordable access to quality networks

• Highlight alternative delivery modalities – e.g., telehealth

• Integrate [Employee Assistance Programs] EAP into a broader employer total health strategy 

• Ensure access to medications through appropriate pharmaceutical benefit management

Improving Quality and Performance

Promote early identification and intervention

• Measure behavioral health performance including accountability metrics

• Integrate mental health within total health and wellbeing strategies

• Support use of personalized medicine

Improving Environment

• Reaffirm the impact of mental health on broader functioning, cognition, and workplace performance as well as other healthcare conditions and costs

• Implement proactive strategies to break the silence and mitigate stigma

• Promote brain wellness, mindfulness, resilience, and other innovative sciences focused on mental health

• Develop a culture focused on wellbeing and performance to reduce chronic stress and positively impact workforce engagement and performance

Implementing these standards can help change the conversation so that employees experience far better outcomes when they’re struggling. This, in turn, is shown to increase attendance and productivity while reducing turnover. As more and more businesses continue to invest in mental health, it will also quickly become a competitive advantage for recruitment, as the most significant percentage of the workforce is also the most impacted by mental health disorders.

The conversation about mental health needs to change. Historically, the attitude has been one of dismissiveness with minimizing admonitions like “man up” or “get it together” often being the reaction to someone admitting they are struggling. This viewpoint is not helpful. It erroneously implies that people struggling with mental illness are choosing to experience difficulties and while avoiding the source of the problem, it also, in turn, exasperates it, making them feel worse, and reducing the likelihood that they will reach out for support again.

Statistically, every workforce has employees suffering from mental illness right now, and the percentage of those who experience it is growing. The toll of ignoring the needs of otherwise productive employees is collectively hurting the economy, costing hundreds of billions of dollars in reactive approaches that could be mitigated by a proactive culture.

The work of many mental health professionals, scientists, doctors, healthcare providers, employers, advocates, government leaders, writers, speakers, and those directly impacted, shows the consensus is clear: this problem is here, it is getting worse, it is mostly being addressed improperly, and there are solutions available to mitigate it. It is up to us to investigate this epidemic, talk about it openly, advocate for positive change, and implement helpful solutions, so that we can all experience a happy, productive, and empowering work environment.

If you or someone you know is experiencing severe mental illness or suicidal thoughts, free, confidential, 24/7 support is available:

National Suicide Prevention Lifeline: 1-800-273-8255
National Suicide Hotline: 1-800-784-2433
Alachua County Crisis Center Crisis Line: (352) 264-6789

About the author:

Photo credit: Suzy Rodriguez

Chris Arias is the Marketing & Communications Chair for ACEL: Alachua County Emerging Leaders and the CEO of Waterbear, a marketing automation consultancy. He is a speaker and writer of business and marketing topics. In his free time, he enjoys checking out live music and hiking Gainesville’s beautiful trails.


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